Barbara A. Chernow, PhD (Columbia University), is the founder of Chernow Editorial Services, Inc., a company that produces medical and professional books for publishers worldwide. She has also edited many reference projects, including the Columbia Encyclopedia, is the author of Beyond the Internet, and has taught at NYU and the New School. She published an article, The Other Side of Grief, in the Brooklyn Quarterly .
Fortunately, cancer awareness has increased, and so have treatment options. One of my goals is to encourage patients and families to maximize their use of available resources to minimize post-treatment challenges and discomfort.
Because I was only 15 years old when my mother was first diagnosed with maxillofacial cancer in 1963, I did not participate in any of the conversations between doctors and adult family members about the extent of the cancer, the surgical approach and the subsequent prosthodontic treatment that would be required. As a result, my memories consist only of what others told me, much of it after the fact. And, those memories were colored by everyone’s shock and disappointment at the long-term effects of the surgery on my mother’s appearance and ability to function. But this was in 1963, a much different time and place. Doctors were less forthcoming, patients were more passive, and viable treatment options for functional rehabilitation were just emerging.
Fortunately, cancer awareness has increased and so have treatment options. One of my goals is to encourage patients and families to maximize their use of available resources to minimize post-treatment challenges and discomfort. This article discusses the diagnosis and information gathering; a subsequent blog will cover treatment options.
Early Detection Lessens Postoperative Deformities
As with all cancers, early detection is critical. A routine physical or dental examination should include a check for oral cancer. See a physician if you experience persistent pain in the mouth and/or face, a mouth sore or lump that does not heal, white or red patches in the mouth, difficulty swallowing, bad breath or enlarged lymph nodes. In my mother’s case, she experienced facial pain and went to her dentist for a checkup. He sent her to an otolaryngologist, who diagnosed a sinus problem. It took months for a third doctor to correctly diagnose her disease as maxillofacial cancer, and several additional weeks for a team of doctors to determine the proper course of surgery. Those delays significantly increased the amount of bone and tissue that had to be removed.
How Is Facial Cancer Diagnosed?
A first step is always a head and neck examination in the doctor’s office that may include the use of mirrors and fiber optic scopes to examine hard-to-see areas. A more thorough procedure, performed in the operating room under an anesthetic, is a panendoscopy, which enables the doctor to examine the oral cavity and areas all the way down to the stomach. If a tumor is found, tissue may be removed for microscopic review. Such a review, known as a biopsy, is the only accurate way to diagnosis oral cancer.
Although imaging tests are not used to diagnose oral cancer, they may be recommended to determine if a tumor has metastasized (spread to other areas). After treatment, imaging studies can help determine if the tumor has been excised or is shrinking.
If cancer is diagnosed, a complete physical, including blood and cardiac testing, should also be performed to determine if you are healthy enough for surgery, radiation therapy and/or chemotherapy. You should also visit your dentist to take care of any routine problems and discuss postoperative options.
Gather Information and Ask Questions: Be Quick, But Not Hasty
Any diagnosis of cancer is frightening. Patients and family members may initially experience depression, anger, confusion and denial, but never have clear heads and rational thinking been more imperative. My mother’s generation was taught to trust a doctor and listen, but not to question. Educational resources were not readily available to the non-specialist. Now, however, accurate and understandable information is abundant.
If a diagnosis of cancer is a possibility, your doctor should refer you to a specialist at a major research hospital that has state-of-the-art equipment and resources, as well as extensive experience in treating the disease. Investigate the credentials of the recommended medical team by reading evaluations of the doctors and hospital online; checking state health department records for complaints; and consulting the National Library of Medicine to see if the doctor has published articles or even participated in clinical trials of possible new treatments. Seek a second opinion from a physician at another facility, even if it is just so that you do not question the diagnosis or approach after treatment begins.
Take the time to learn about treatment options by checking the websites of major research hospitals, such as the Mayo Clinic, Memorial Sloan Kettering Cancer Center or MD Anderson Cancer Center, or of professional organizations, such as the Oral Cancer Foundation and the American Society of Clinical Oncology (ASCO), that provide accurate information for the patient and family. In short, do your homework upfront; it helps avoid regrets and anger, neither of which are productive to recovery and rehabilitation. Your goal is to trust your medical team, be informed about the disease and clearly understand treatment options and their life-effects, so that you are as comfortable as possible with the approach selected and its outcome.